الفهرس 
Neonatal SepsisOnly 14 pages are availabe for public view
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Abstract
Neonatal septicemia considered as a grave life-threatening condition with significant morbidity and mortality. Early accurate diagnosis and treatment is fundamental to improve outcome. Decrease this mortality represent chief challenge in emergency medicine as blood culture used to confirm sepsis takes several days and undergo either contamination or false negatives results. Thus recognition of precise biomarkers to aid in its suitable and accurate diagnosis is vital. Among biomarkers, SAA and presepsin could be the most hopeful and dependable biomarker for early diagnosis of sepsis.
Current study aimed to assess the role presepsin and SAA as simple predictor tests for early diagnosis of neonatal sepsis and its usefulness in the early diagnosis of neonatal sepsis in comparison with CRP and HSS.
It was carried out in neonatal intensive care unit (NICU) in both 6 October Insurance Hospital and El-Warrak Central Hospital (governmental Hospital) in collaboration with faculty of Postgraduate Childhood Studies. Cases were recruited over 1 year period from June 2017 to May 2018.
Patient group: 60 cases with suspected sepsis either by clinical or laboratory score admitted to the Neonatal Intensive care unit (NICU).
Control group: 30 healthy neonates selected from the observation part of the NICU.
All neonates included in the study were subjected to the following:
History
Birth weight
Mode of delivery
Maternal obstetric and gynecological history such as:
o Prolonged rupture of membranes (PROM).
o Maternal peripartum fever or persistent infection.
o Amniotic fluid problems (i.e. meconium, chorioamnionitis)
Resuscitation at birth with ambo bag or tube, fetal distress or any other use of invasive procedures.
Clinical examination
Complete clinical examination to exclude any congenital anomalies.
Griffin Neonatal Sepsis Score for Neonatal sepsis (clinical and HSS)
Anthropometric measurement (weight, Length, weight/ Length, weight/ Head circumference and BMI), were calculated using standardized equipment’s.
Laboratory testing of Serum Presepsin, Serum Amyloid A and CRP done while repeated CBC, CRP and blood culture were collected from patients records.
Results of the present study showed the following:
Maternal fever and premature rupture of membrane (PROM) by 88.1%, 80.0% respectively were most common risk factors for sepsis while hypothermia and Respiratory distress were established as the most common clinical presentations.
Blood cultures were positive in 90% of our cases, Kelebsiella with its different types was the dominant (53.3%) followed by Staphylococcus aureous (20.00%).
Both CRP level and HSS were significantly elevated in patient group than control group as well as in proven sepsis group after 72hours than admission.
TLC, platelets count and I/T ratio were informative in diagnosis of neonatal sepsis as shown there were statistically significance difference between cases and control while were useless in septic group after 72hours than admission.
Both presepsin and SAA were informative in diagnosis of neonatal sepsis as shown in there were statistically significance difference between cases and control.
The cut off value were 7.0 for CRP while presepsin and SAA were 64.2, 151.3 respectively, regarding sensitivity of the markers: presepsin was the most sensitive (93.3%) followed by SAA and lastly CRP (85.0%) while specificity waere: presepsin and SAA came first sensitive equally by (100%) then CRP (86.7 %) as regard positive predictive value (PPV) of the markers presepsin and SAA came first sensitive equally by (100%) then CRP (92.7 %). Finally Presepsin had the highest negative predictive value (NPV) (88.2%) followed by SAA (85.7 %) compared to CRP (74.3 %).
In conclusion
-Presepsin as well as SAA are accurate and highly sensitive and specific marker either for predict or diagnosis of sepsis in contrast to CRP or HSS.
Limitation of the study
Number of cases as well as controls included in the study was small to allow generalization of the conclusion of the study.